Perinatal mood disorders such as postpartum depression and postpartum posttraumatic stress disorder are an area of growing concern. There have been few studies regarding ways to identify women at risk of developing these disorders in the antepartum period. During the antepartum period, women attend prenatal appointments with their provider to assess the health of their pregnancy. This period is ideal to administer emotional health questionnaires to identify if patients may be at risk of developing postpartum mood disorders. The aim of this study was to identify if there are differences on antepartum emotional health questionnaire scores between women who have postpartum mood disorders, and those who do not. The data come from 19 women undergoing scheduled cesarean deliveries at Boston Medical Center. The questionnaires collected information about stress, depression, anxiety, and symptoms of postpartum depression and posttraumatic stress disorder. We compared the scores of the women who had postpartum depression and postpartum posttraumatic stress disorder to the women who did not, to examine if the scores in the antepartum period correlated with postpartum mood disorders. We did not find any differences between the postpartum depression group, but did find a difference on one questionnaire between the postpartum posttraumatic stress disorder group. Within our cohort, we found similar incidences of postpartum depression, postpartum posttraumatic stress disorder, and self-harm/suicidal ideations compared to national incidences. Future studies should include more participants and a more heterogenous cohort as it pertains to cesarean delivery type, indication for cesarean delivery, intrapartum events, and histories of depression, anxiety, posttraumatic stress disorder, and other mood disorders. Although we only found a difference on one questionnaire for one of the postpartum mood disorders, future studies should prioritize the antepartum period as a time to identify and address concerns of postpartum mood disorders.

Posttraumatic stress disorder (PTSD) is accompanied by marked alterations in cognition and behavior, particularly when negative, high-value information is present (Aupperle, Melrose, Stein, & Paulus, 2012; Hayes, Vanelzakker, & Shin, 2012) . However, the underlying processes are unclear; such alterations could result from differences in how this high value information is updated or in its effects on processing future information. To untangle the effects of different aspects of behavior, we used a computational psychiatry approach to disambiguate the roles of increased learning from previously surprising outcomes (i.e. associability; Li, Schiller, Schoenbaum, Phelps, & Daw, 2011) and from large value differences (i.e. prediction error; Montague, 1996; Schultz, Dayan, & Montague, 1997) in PTSD. Combat-deployed military veterans with varying levels of PTSD symptoms completed a learning task while undergoing fMRI; behavioral choices and neural activation were modeled using reinforcement learning. We found that associability-based loss learning at a neural and behavioral level increased with PTSD severity, particularly with hyperarousal symptoms, and that the interaction of PTSD severity and neural markers of associability based learning predicted behavior. In contrast, PTSD severity did not modulate prediction error neural signal or behavioral learning rate. These results suggest that increased associability-based learning underlies neurobehavioral alterations in PTSD. / Master of Science

The present study aimed to investigate sleep disturbances and negative emotions as predictors of posttraumatic stress disorder (PTSD) symptom trajectories in a publicly available longitudinal dataset of patients (N = 1127; mean age = 36.53; SD = 13.29; 65.5% women) who presented to a U.S. emergency department (ED) in the early aftermath of a trauma exposure. Latent growth curve models were fitted iteratively to characterize PTSD symptom trajectories over 1-year. Models then examined the simultaneous influence of sleep disturbances (i.e., insomnia symptoms, nightmares, and sleep duration) and negative emotions (i.e., feelings of anxiety and depression) on PTSD symptom trajectories, as well as whether negative emotions mediate the link between sleep disturbances and PTSD symptom trajectories. Results indicated that (a) PTSD symptom trajectories reflected a quadratic trend across time, although there was variability between individuals, (b) both sleep disturbances and negative emotions were uniquely associated with PTSD symptom trajectories, and (c) negative emotions partially explained associations between sleep disturbances and PTSD symptom trajectories. The results from this study can potentially aid detection of modifiable risk factors during the early course of PTSD and inform cognitive-behavioral intervention efforts.

A prospective study of pregnant women was undertaken to provide an estimate of rates of Posttraumatic Stress Disorder after childbirth that takes into account pre-existing trauma; to explore risk factors associated with the development of traumatic stress after birth; and to better understand incidence and risk factors associated with fear of childbirth, which is thought to contribute to postpartum Posttraumatic Stress Disorder. Ninety participants in their last trimester of pregnancy completed questionnaires that included depression, trait anxiety, PTSD, anxiety sensitivity, childbearing fear, and self-efficacy for labor. Four weeks after delivery 73 of these women completed questionnaires concerning delivery, posttraumatic stress related to childbirth, and depression. Levels of childbearing fear were similar to studies of non U.S. women but did not predict traumatic reactions to childbirth. First-time mothers and those with prior miscarriage, traumatic birth, and childhood sexual assault were not more fearful of childbirth although women reporting repeat sexual victimization that started in childhood were. Women with comorbid Posttraumatic Stress Disorder and depression during pregnancy were significantly more fearful of childbirth. Higher trait anxiety and anxiety sensitivity, and lower labor self-efficacy predicted greater fear of childbirth. Women who underwent operative deliveries became more fearful of childbirth after delivery whereas women who underwent unassisted vaginal deliveries showed a reduction in fear. Five percent of women developed new cases of Posttraumatic Stress Disorder attributable to childbirth. An additional five percent who had received a trauma diagnosis during pregnancy met criteria for Posttraumatic Stress Disorder resulting from childbirth. Higher trait anxiety predicted postpartum trauma symptoms and greater self-efficacy for childbirth moderated this relationship. Women assigned a diagnosis of Posttraumatic Stress Disorder or co-morbid PTSD and depression during pregnancy, and women who underwent operative or instrument deliveries (i.e. caesarian section, forceps deliveries, or vacuum extraction), were significantly more likely to receive a diagnosis of PTSD or trauma-related Adjustment Disorder as a consequence of their experience of childbirth. Results suggest that increasing self-efficacy for labor and treating psychopathology present during pregnancy may be fruitful targets for efforts to prevent the development of traumatic reactions to childbirth.

Combat-related posttraumatic stress disorder (PTSD) is a psychological condition researchers have cited as a major cause of marital discord and divorce for veterans with PTSD. This study examined the psychological construct of locus of control among the wives of veterans diagnosed with combat-related PTSD and whether or not it was a predictor of marital satisfaction within this context. An extensive search of the current literature revealed no previous studies that had investigated this relationship. Utilizing the family systems theory to address this gap, this study sought to compare reported marital satisfaction in wives with an internal locus of control to those with an external locus of control. Participants for this study were 111 wives of veterans with combat-related PTSD, each of whom completed a demographic questionnaire, the Kansas Marital Satisfaction Survey, and the Duttweiler Internal Control Index. A multiple linear regression was conducted to determine if age, number of years married, number of children, level of education, household income, and internal locus of control were predictors of marital satisfaction reported by wives of veterans with combat-related PTSD. The results indicated that an internal locus of control accounted for a significant degree of the variance in marital satisfaction while the demographic variables were not significant predictors. This study contributes to social change by providing an empirical insight into the relationship between locus of control and marital satisfaction in wives of veterans with PTSD. The results of this study could help improve the quality of life of veterans with PTSD by enhancing awareness of locus of control to practitioners while developing a therapeutic treatment plan that will fit the veteran's locus of control orientation.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder characterised by disturbed arousal, altered attention, and fear processing, and a reduction in the ability to perform cognitive tasks. Predominant neurophysiological models of PTSD have been focused on alterations in fear-related regulation, and few incorporate broader changes in generic executive control which may underlie many of the clinical symptoms and cognitive deficits in PTSD. This thesis aimed to investigate the neurophysiology of executive inhibitory control in PTSD using a Go/NoGo response inhibition task and converging functional imaging, structural imaging and electrophysiological measures. The first series of studies aimed to elucidate a normative neural network model of inhibitory control, and are consistent with normative control involving the activation of a mainly right-lateralised ventral lateral prefrontal cortex (VLPFC) network. Inhibitory control-related activation was found to be affected by levels of anxiety and changes in underlying neural structure; alterations in frontal cortical maturation and volume were related to additional activation of bilateral frontal cortical regions and the dorsal striatum, with anxiety increasing the demand on inhibitory control-related activation. In contrast to healthy participants, PTSD was associated with reduced inhibitory control as indexed by inhibitory behaviour, diminished activation of the right VLPFC, and slowed inhibition-related information processsing. PTSD participants relied on the greater activation of a left fronto-striatal inhibition network to support control, with the activation affected by levels of PTSD severity and comorbid anxiety. This left fronto-striatal activation in PTSD was related to underlying increases in fronto-striatal neural structure. Further, the ability to efficiently engage a left fronto-striatal network in PTSD during inhibitory control predicted better response to cognitive behavior for PTSD, consistent with the proposal that an improved ability to flexibly engage control systems may facilitate the resolution of PTSD symptoms. Taken together, this program of research extends current neurophysiological model of PTSD to show that PTSD involves a fundamental disturbance in the function and structure of key fronto-striatal response control networks associated with inhibitory control.

Doctor of Clinical Psychology/ Master of Science (DCP/ MSc) / A number of international studies reveal high prevalence rates of posttraumatic stress disorder (PTSD) within homeless populations. Recent research on PTSD indicates that cognitive responses to trauma are critical in determining who develops the disorder. In Australia, a number of studies indicate exceptionally high rates of trauma experience among homeless adults, yet PTSD has not been investigated in this cohort. Therefore, the primary aim of this project was to improve understanding of PTSD and related cognitions in a sample of homeless adults in Sydney. The project attempts to determine the prevalence of PTSD and its onset in relation to homelessness (Study One) and also explores the role of cognitions in PTSD (Study Two). The sample consisted of seventy homeless men and women aged 18 to 73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted for each participant. The majority of the sample stated that they had experienced at least one traumatic event in their lifetime (98.2%). The twelve-month prevalence of PTSD was higher among homeless adults in Sydney in comparison to the Australian general population (41.1% versus 1.5%). In 59.1% of cases, the onset of PTSD was found to have occurred before the age of the first reported homeless episode. In a comparison of those with and without a current diagnosis of PTSD, it was found that those with PTSD scored significantly higher overall on measures of posttraumatic cognitions and early maladaptive schemas. In particular, this group scored higher on schemas that centre on the world being entirely dangerous and the self being totally inept. A mediational analysis showed that when trauma and mental health care were controlled, the relationship between early maladaptive schemas and PTSD symptom severity was mediated by posttraumatic cognitions. It was concluded that homeless adults in Sydney frequently experience trauma and PTSD, which typically precedes homelessness. It was also concluded that among homeless adults, posttraumatic cognitions and early maladaptive schemas appear to play an important role in PTSD and may be associated with symptom severity. These findings have implications for public policy on homelessness and mental health, homeless service provision, PTSD theory, and PTSD treatment for homeless adults.

Traditionally, it was believed that young children did not experience long-term negative effects resulting from a traumatic experience. Many professionals continue to assume that the effects of trauma on infants (0-3 years) are transient and that intervention is unnecessary. However, research has shown that infants and young children can develop posttraumatic stress disorder (PTSD; Scheeringa, Peebles, Cook, & Zeanah, 2001). Symptoms consistent with older children and adults (i.e., re-experiencing, avoidance/emotional numbing, and hyperarousal) have been found with infants and young children exposed to trauma. The purpose of this dissertation was to better understand the nature of trauma in early childhood using a multidimensional approach. Three studies were conducted to determine the effects of trauma and PTSD on young children. Study 1 considered the effectiveness of using the Child Behaviour Checklist (CBCL), a popular measure of childrens adjustment, to screen for PTSD symptoms in a sample of young children. Results suggested that the PTSD subscale of the CBCL correctly identified 71% of children with PTSD. Study 2 examined the role that potentially traumatic events, as well as family and child characteristics, play in the development of symptoms of PTSD by surveying a community sample. Results suggested that certain events were more likely to be associated with symptoms of PTSD and that children with younger mothers and higher rates of internalizing problems were more likely to experience symptoms of PTSD. Study 3 explored the effects of trauma on young childrens emotional, physiological and relational functioning, and was conducted in two phases: Phase I considered PTSD symptom expression, physiological stress-response (i.e., salivary cortisol) and quality of attachment in children recruited from a community sample; and Phase II considered PTSD symptoms, quality of attachment and maternal psychological distress in the development of PTSD in a clinical sample of young children. Results found that in Phase I PTSD symptoms were not associated with either cortisol level or quality of attachment, although effect sizes were moderate. Phase II results found a direct and significant association between quality of attachment and PTSD symptoms. A non-significant but moderate effect size was found for the link between maternal psychological distress and PTSD symptoms. Findings are discussed with regards to their implications for future research and clinical practice.

This study examined the role of filial responsibility as a mediator between parental depression and posttraumatic stress symptomatology (PTSS) in Bosnian youths. The sample consisted of 145 6PthP-8PthP grade boys and girls and their parents. Unfairness and caregiving scales were combined in an interaction term to test the hypothesis. Parental depression significantly predicted parental report of adolescent PTSS but the filial responsibility variables did not significantly mediate the relationship between parental depression and PTSS. A post-hoc analysis examined the role of filial responsibility mediating the relationship between parental education level and PTSS. The interaction terms did not significantly mediate the relationship but the unfairness variable significantly mediated the relationship between parental education level and adolescent report of PTSS.

Traditionally, it was believed that young children did not experience long-term negative effects resulting from a traumatic experience. Many professionals continue to assume that the effects of trauma on infants (0-3 years) are transient and that intervention is unnecessary. However, research has shown that infants and young children can develop posttraumatic stress disorder (PTSD; Scheeringa, Peebles, Cook, & Zeanah, 2001). Symptoms consistent with older children and adults (i.e., re-experiencing, avoidance/emotional numbing, and hyperarousal) have been found with infants and young children exposed to trauma. The purpose of this dissertation was to better understand the nature of trauma in early childhood using a multidimensional approach. Three studies were conducted to determine the effects of trauma and PTSD on young children. Study 1 considered the effectiveness of using the Child Behaviour Checklist (CBCL), a popular measure of childrens adjustment, to screen for PTSD symptoms in a sample of young children. Results suggested that the PTSD subscale of the CBCL correctly identified 71% of children with PTSD. Study 2 examined the role that potentially traumatic events, as well as family and child characteristics, play in the development of symptoms of PTSD by surveying a community sample. Results suggested that certain events were more likely to be associated with symptoms of PTSD and that children with younger mothers and higher rates of internalizing problems were more likely to experience symptoms of PTSD. Study 3 explored the effects of trauma on young childrens emotional, physiological and relational functioning, and was conducted in two phases: Phase I considered PTSD symptom expression, physiological stress-response (i.e., salivary cortisol) and quality of attachment in children recruited from a community sample; and Phase II considered PTSD symptoms, quality of attachment and maternal psychological distress in the development of PTSD in a clinical sample of young children. Results found that in Phase I PTSD symptoms were not associated with either cortisol level or quality of attachment, although effect sizes were moderate. Phase II results found a direct and significant association between quality of attachment and PTSD symptoms. A non-significant but moderate effect size was found for the link between maternal psychological distress and PTSD symptoms. Findings are discussed with regards to their implications for future research and clinical practice.